Stomach Bug Crystallizes an Antibiotic Threat

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The New York Times

April 14, 2009

Well

Stomach Bug Crystallizes an Antibiotic Threat

By TARA PARKER-POPE

Earlier this year, Harold and Freda Mitchell of Como, Miss., both came down with a serious stomach bug. At first, doctors did not know what was wrong, but the gastrointestinal symptoms became so severe that Mrs. Mitchell, 66, was hospitalized for two weeks. Her husband, a manufacturing supervisor, missed 20 days of work.

A local doctor who had worked in a Veterans Affairs hospital recognized the signs of Clostridium difficile, a contagious and potentially deadly bacterium. Although the illness is difficult to track, health officials estimate that in the United States the bacteria cause 350,000 infections each year in hospitals alone, with tens of thousands more occurring in nursing homes. While the majority of cases are found in health care settings, 20 percent or more may occur in the community. The illness kills an estimated 15,000 to 20,000 people annually.

“It’s been the worst thing I’ve ever tried to get through in my life,” said Mrs. Mitchell, who remains weakened by the ordeal. “I really did think I was going to die.”

What is so frightening about C. difficile is that it is often spurred by antibiotics. The drugs wipe out the targeted illness, like a urinary tract or upper respiratory infection, but they also kill off large portions of the healthy bacteria that normally live in the digestive tract. If a person comes into contact with C. difficile, or already has it, the disruption to the beneficial bacteria creates an opportunity for the harmful bacteria to flourish.

The public health community has been sounding the alarm for years about the overuse of antibiotics and the emergence of “superbugs” — bacteria that have developed immunity to a wide number of antibiotics. But the C. difficile problem shows that the threat is not generalized or hypothetical, but immediate and personal.

“One of the things that we counsel consumers about is to make sure that an antibiotic is really necessary,” said Dr. Dale N. Gerding, an infectious disease specialist at the Stritch School of Medicine at Loyola University in Chicago. “There are many good reasons for taking an antibiotic, but an illness like sinusitis or bronchitis winds up being treated with antibiotics even though it will go away by itself anyway.”

Even appropriate use of antibiotics can put a person at risk. Dr. Gerding said his own adult son came down with a C. difficile infection after taking antibiotics for tonsillitis.

The typical treatment for C. difficile is another course of antibiotics, typically the drug vancomycin. But the situation can quickly turn tragic. The Centers for Disease Control and Prevention has reported on several cases of pregnant and postpartum women who developed life-threatening C. difficile infections after being treated for minor infections. In some instances, a C. difficile infection can be treated only by emergency surgery to remove the patient’s colon. Doctors say many patients report that they continue to suffer from regular bouts of diarrhea even after the infection is gone. About 20 percent of patients with the infection suffer a relapse, and C. difficile support groups have emerged on the Internet.

In the case of the Mitchell family, Mr. Mitchell had been taking antibiotics for another health problem, and the treatment apparently led to his C. difficile infection. Mrs. Mitchell probably contracted the illness from her husband. The spores from C. difficile are hardy, and contaminated surfaces must be scrubbed down with bleach to eradicate the germ. Doctors say Mrs. Mitchell’s illness is unusual because most people are protected by their own bacterial flora and wouldn’t be vulnerable to C. difficile if they had not been taking antibiotics, even after close exposure. The risk of contracting C. difficile outside the health care setting remains low, at about 7 cases per 100,000 people, studies show.

C. difficile is not a new illness, but it appears to be spreading at an alarming rate. The rate of C. difficile infection among hospital patients doubled from 2001 to 2005, according to an April 2008 report from the C.D.C. The rise in C. difficile cases around the world is linked with the growing use of all antibiotics, particularly a class of drugs called fluoroquinolones, which came into widespread use around 2001. The use of acid-suppressing drugs, including proton pump inhibitors like Prilosec, also may be a risk factor, although studies have been contradictory.

In addition to becoming more common, C. difficile is also becoming more deadly. Several years ago, the mortality rate from a C. difficile infection was around 1 to 2 percent. But today, various studies estimate that the death rate is 6 percent. The reason is that a hypervirulent strain has emerged that emits higher levels of toxins than earlier strains.

Many patients are far more familiar with another superbug, methicillin-resistant Staphylococcus aureus, or MRSA, which can cause a severe and potentially deadly skin infection. MRSA started off primarily as a hospital-based infection but has become increasingly common in the community.

Hospitals may become more motivated to control C. difficile if the Centers for Medicare and Medicaid Services decides to withhold reimbursement for cases of hospital-acquired C. difficile infections. The system already withholds reimbursement for certain other preventable hospital infections.

In addition to careful use of antibiotics, patients and hospital visitors should always be vigilant about hand washing, and visitors should not sit on a patient’s hospital bed or use a patient’s restroom if it can be avoided. Patients should always report severe diarrhea symptoms to a doctor, particularly if they have taken antibiotics recently.

“Up until about 2002, this was a very mild disorder and very few people ever died from it,” said Dr. Perry Hookman, a gastroenterologist and associate professor of medicine at the Miller School of Medicine at the University of Miami. “But in the past few years the bugs have become hypervirulent, more severe and now it’s a global threat.”

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coyote Members Profile Send Private Message Find Members Posts Add to Buddy List Admin Group Joined: April 25 2007 Location: United States Status: Offline Points: 8395	Post Options Post Reply Quote coyote Report Post Thanks(0) Quote Reply Topic: Stomach Bug Crystallizes an Antibiotic Threat Posted: April 14 2009 at 10:29am
	The New York Times April 14, 2009 Well Stomach Bug Crystallizes an Antibiotic Threat By TARA PARKER-POPE Earlier this year, Harold and Freda Mitchell of Como, Miss., both came down with a serious stomach bug. At first, doctors did not know what was wrong, but the gastrointestinal symptoms became so severe that Mrs. Mitchell, 66, was hospitalized for two weeks. Her husband, a manufacturing supervisor, missed 20 days of work. A local doctor who had worked in a Veterans Affairs hospital recognized the signs of Clostridium difficile, a contagious and potentially deadly bacterium. Although the illness is difficult to track, health officials estimate that in the United States the bacteria cause 350,000 infections each year in hospitals alone, with tens of thousands more occurring in nursing homes. While the majority of cases are found in health care settings, 20 percent or more may occur in the community. The illness kills an estimated 15,000 to 20,000 people annually. “It’s been the worst thing I’ve ever tried to get through in my life,” said Mrs. Mitchell, who remains weakened by the ordeal. “I really did think I was going to die.” What is so frightening about C. difficile is that it is often spurred by antibiotics. The drugs wipe out the targeted illness, like a urinary tract or upper respiratory infection, but they also kill off large portions of the healthy bacteria that normally live in the digestive tract. If a person comes into contact with C. difficile, or already has it, the disruption to the beneficial bacteria creates an opportunity for the harmful bacteria to flourish. The public health community has been sounding the alarm for years about the overuse of antibiotics and the emergence of “superbugs” — bacteria that have developed immunity to a wide number of antibiotics. But the C. difficile problem shows that the threat is not generalized or hypothetical, but immediate and personal. “One of the things that we counsel consumers about is to make sure that an antibiotic is really necessary,” said Dr. Dale N. Gerding, an infectious disease specialist at the Stritch School of Medicine at Loyola University in Chicago. “There are many good reasons for taking an antibiotic, but an illness like sinusitis or bronchitis winds up being treated with antibiotics even though it will go away by itself anyway.” Even appropriate use of antibiotics can put a person at risk. Dr. Gerding said his own adult son came down with a C. difficile infection after taking antibiotics for tonsillitis. The typical treatment for C. difficile is another course of antibiotics, typically the drug vancomycin. But the situation can quickly turn tragic. The Centers for Disease Control and Prevention has reported on several cases of pregnant and postpartum women who developed life-threatening C. difficile infections after being treated for minor infections. In some instances, a C. difficile infection can be treated only by emergency surgery to remove the patient’s colon. Doctors say many patients report that they continue to suffer from regular bouts of diarrhea even after the infection is gone. About 20 percent of patients with the infection suffer a relapse, and C. difficile support groups have emerged on the Internet. In the case of the Mitchell family, Mr. Mitchell had been taking antibiotics for another health problem, and the treatment apparently led to his C. difficile infection. Mrs. Mitchell probably contracted the illness from her husband. The spores from C. difficile are hardy, and contaminated surfaces must be scrubbed down with bleach to eradicate the germ. Doctors say Mrs. Mitchell’s illness is unusual because most people are protected by their own bacterial flora and wouldn’t be vulnerable to C. difficile if they had not been taking antibiotics, even after close exposure. The risk of contracting C. difficile outside the health care setting remains low, at about 7 cases per 100,000 people, studies show. C. difficile is not a new illness, but it appears to be spreading at an alarming rate. The rate of C. difficile infection among hospital patients doubled from 2001 to 2005, according to an April 2008 report from the C.D.C. The rise in C. difficile cases around the world is linked with the growing use of all antibiotics, particularly a class of drugs called fluoroquinolones, which came into widespread use around 2001. The use of acid-suppressing drugs, including proton pump inhibitors like Prilosec, also may be a risk factor, although studies have been contradictory. In addition to becoming more common, C. difficile is also becoming more deadly. Several years ago, the mortality rate from a C. difficile infection was around 1 to 2 percent. But today, various studies estimate that the death rate is 6 percent. The reason is that a hypervirulent strain has emerged that emits higher levels of toxins than earlier strains. Many patients are far more familiar with another superbug, methicillin-resistant Staphylococcus aureus, or MRSA, which can cause a severe and potentially deadly skin infection. MRSA started off primarily as a hospital-based infection but has become increasingly common in the community. Hospitals may become more motivated to control C. difficile if the Centers for Medicare and Medicaid Services decides to withhold reimbursement for cases of hospital-acquired C. difficile infections. The system already withholds reimbursement for certain other preventable hospital infections. In addition to careful use of antibiotics, patients and hospital visitors should always be vigilant about hand washing, and visitors should not sit on a patient’s hospital bed or use a patient’s restroom if it can be avoided. Patients should always report severe diarrhea symptoms to a doctor, particularly if they have taken antibiotics recently. “Up until about 2002, this was a very mild disorder and very few people ever died from it,” said Dr. Perry Hookman, a gastroenterologist and associate professor of medicine at the Miller School of Medicine at the University of Miami. “But in the past few years the bugs have become hypervirulent, more severe and now it’s a global threat.”
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abcdefg Members Profile Send Private Message Find Members Posts Add to Buddy List Valued Member Joined: September 19 2008 Status: Offline Points: 578	Post Options Post Reply Quote abcdefg Report Post Thanks(0) Quote Reply Posted: April 19 2009 at 3:40am
	This one really strikes home. My mother died of this in 2000. I have done a lot of research on it, the bad strain that is the killer came out of Canada, my mother who lives in MN which borders canada was one of the first to die of this newer more lethal disease. The first Dr. she saw was a surgeon, he said she whould be disemboweled the other Dr.s and our family though the guy was nuts, had we listened to him, she may be alive to day. One time of the year to be particularily vigilent about this disease is during colds and flu season. Often if you call the Dr. they will tell you you have a bug that is going around and to take medications to stop the diahrea which is the worst possible thing to do. It causes the infection to stay up in the body reproudicing. The infection actually is shapped like a cork screw and it literally screws itself into your intestines. There are so many folds in the inestines it is hard to get all of the spores they call them and everyone needs to be re checked without exception in two weeks, one is not truly cured unitl they have passed three negative stool cultures. Often people forget to go back in when they begin feeling better. If you get a flu and the symptoms of loose stools continue on or smell worse then normal and you know, trust me, you need to get checked out. Take the age of the person and their other illness into account when you decide how to treat them. Elderly peopole tend to have far more under lyding pre existing conditions. Making it in my opinion perhaps wiser to go with some radical surgery right away when they are still strong enough to handle it. Also while you are hospitalized make sure that all meds you normally take are administered. Especially if the patient takes thyroid medicaions, in emergencies you can forget a lot. If Thyroid meds are not maintained then the vankomycin and the flaygl stay in the system not being able to be passed out, this kills the kidneys then you have to bodily organs failing. The death is awful and painful, as your insides are slowly eaten up. The C diff becomes toxic and the patient bloats up because the heart and lungs are not functioning properly because they are not able to get up and move and they fill with fluid. Making it even harder on the heart and the lungs. They can not eat anything by mouth so they continue to gte more and more weak as they need to be stronger. Although the route of getting this through anti biotiic use is the most common, there are many other ways one can get it also. From public restrooms, from cleaning up pet messes and not properly washing hands, from cleaning baby diapers and not properly washing hands, from contaminated equipment used to do colonoscopies. When you have a colonoscopy or use anti biotic I would strongly suggest using some pro biotic to help replace you natural flora in your colon. Another thing that can be done is to give the patient the natural medicine acidphplus and use it as a enema it gets the flora where it is needed, but this needs to be done early on while there is still colon. the spores will truly eat up the whole colon. Anyone who wants or needs to hear more about this, feel free to contact me. I lived this for several months watching my healthy vibrant mother die organ by organ. I beileve this is traveling down the country and by now is most everywhere. Please be careful. It is here and it is ugly.

Wishbone Members Profile Send Private Message Find Members Posts Add to Buddy List V.I.P. Member Joined: January 08 2009 Status: Offline Points: 142	Post Options Post Reply Quote Wishbone Report Post Thanks(0) Quote Reply Posted: April 19 2009 at 7:20am
	FOR YOUR INTESTINAL FLORA, KEEP A BATCH OF KEFIR GOING AT ALL TIMES: http://users.sa.chariot.net.au/~dna/kefirpage.html I AM NOT AFFILIATED WITH DOMINIC, BUT I HAVE PURCHASED KEFIR IN THE U.S.A. It must be kept alive. It is a living thing, and it needs fresh milk at least once a week. Kefir will also keep milk and cream from spoiling if there is no refrigeration, but it does turn it to a yogurt like drink within 24 hours. It grows best in whole milk. It really does not thrive in canned milk, or dried, or skim milk. It does very well in fresh goats milk from the dairy also. I am not fond of goats milk, but if I ferment it for a couple of days with kefir, it tastes great. It does multiply, so you can share it with others, but anyone I shared it with let it die. People are very hesitant to try anything new. Although this has been around for thousands of years. Because it has so many different probiotics, I think this would save a lot of lives.

Wishbone Members Profile Send Private Message Find Members Posts Add to Buddy List V.I.P. Member Joined: January 08 2009 Status: Offline Points: 142	Post Options Post Reply Quote Wishbone Report Post Thanks(0) Quote Reply Posted: April 19 2009 at 7:44am
	Microorganisms Found in Different Batches of Milk Kefir-Grains and Kefir Divided into Four Genus Groups [with revised nomenclature] http://users.sa.chariot.net.au/~dna/kefirpage.html#composition-of-KG

Annie Members Profile Send Private Message Find Members Posts Add to Buddy List Valued Member Joined: April 06 2009 Location: East Texas Status: Offline Points: 319	Post Options Post Reply Quote Annie Report Post Thanks(0) Quote Reply Posted: April 20 2009 at 4:43pm
	abcdefg: I am sorry your mom died such a horrible death. I pray her death and the story you've shared will save many from the torture she suffered. Thank you for the detailed information of the cause and effect of this illness. Annie
	Dense populations are going to be hit very hard by this pestiferousness little (flu virus) monster. "Technologist" Stock 3 months water, food, weapon/ammo, meds, supplies, and some money at home.

Stomach Bug Crystallizes an Antibiotic Threat

Microorganisms Found in Different Batches of Milk Kefir-Grains and Kefir